Pneumatic Compression Devices in Prevention of Intradialytic Hypotension

Introduction: Patients in hemodiafiltration (HDF) eliminate volume overload by ultrafiltration. Vascular volume loss is among the main mechanisms contributing to adverse events such as intradialytic hypotension. Here, we hypothesize that the intradialytic exercise (IDEX) is an intervention that could improve the acute response of physiological mechanisms involved during vascular volume loss. To test this hypothesis, we evaluated the hemodynamic response to mild aerobic exercise during HDF. Methods: Nineteen end-stage renal disease (ESRD) patients (11 women: 40 ± 10.8 years old, and 8 men: 42 ± 21 years old) receiving HDF thrice a week, with 6 months of previous physical conditioning, participated in this study. Three HDF sessions were scheduled for each patient: 1 resting in supine position, 1 resting in sitting position, and 1 doing aerobic exercise. The first 2 sessions were taken as control. The ultrafiltration rate was set to 800 mL/h in each session. The hemodynamic response was monitored through the relative blood volume (RBV), and cardiovascular variables measured noninvasively by photoplethysmography. Adequacy variables such as Kt/V and percentage reduction of urate, urea, creatinine (Cr), and phosphate were also monitored. Findings: The decrease rate of the RBV was smaller in the session with IDEX compared to the sessions with no exercise. No differences were found neither in the cardiovascular variables nor in the adequacy variables among the 3 sessions. There were no hypotension events during the session with exercise, and 8 events during the sessions without exercise (p = 0.002). Discussion: Mild exercise during HDF decreased the RBV drop and was associated with less hypotension events. The lack of differences in the hemodynamic variables suggests an adequate acute response of cardiovascular compensation variables to intradialytic hypovolemia.

Download Full-text

OCT angiography metrics predict intradialytic hypotension episodes in chronic hemodialysis patients: a pilot, prospective study

Scientific Reports ◽

10.1038/s41598-021-86609-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Giuseppe Coppolino ◽

Adriano Carnevali ◽

Valentina Gatti ◽

Caterina Battaglia ◽

Giorgio Randazzo ◽

...

Keyword(s):

Chronic Hemodialysis ◽

Dialysis Session ◽

Intradialytic Hypotension ◽

Inverse Association ◽

Non Invasive ◽

Kaplan Meier ◽

Optimal Thresholds ◽

Scanning Area ◽

Before And After ◽

Capillary Plexus

AbstractIn chronic hemodialysis (HD) patients, intradialytic hypotension (IDH) is a complication that increases mortality risk. We run a pilot study to analyzing possible relationships between optical coherence tomography angiography (OCT-A) metrics and IDH with the aim of evaluating if OCT-A could represent a useful tool to stratify the hypotensive risk in dialysis patients. A total of 35 eyes (35 patients) were analyzed. OCT-A was performed before and after a single dialysis session. We performed OCT-A 3 × 3 mm and 6 × 6 mm scanning area focused on the fovea centralis. Patients were then followed up to 30 days (10 HD sessions) and a total of 73 IDHs were recorded, with 12 patients (60%) experiencing at least one IDH. Different OCT-A parameters were reduced after dialysis: central choroid thickness (CCT), 6 × 6 mm foveal whole vessel density (VD) of superficial capillary plexus (SPC) and 6 × 6 mm foveal VD of deep capillary plexus (DCP). At logistic regression analysis, IDH was positively associated with baseline foveal VD of SCP and DCP, while an inverse association was found with the choroid. In Kaplan–Meier analyses of patients categorized according to the ROC-derived optimal thresholds, CCT, the 3 × 3 foveal VD of SCP, the 3 × 3 mm and 6 × 6 mm foveal VD of DCP and the 6 × 6 mm foveal VD of SCP were strongly associated with a higher risk of IDH over the 30-days follow-up. In HD patients, a single OCT-A measurement may represent a non-invasive, rapid tool to evaluate the compliance of vascular bed to HD stress and to stratify the risk of IDH in the short term.

Download Full-text

Definitions of intradialytic hypotension

Seminars in Dialysis ◽

10.1111/sdi.12626 ◽

2017 ◽

Vol 30 (6) ◽

pp. 464-472 ◽

Cited By ~ 16

Author(s):

Magdalene M. Assimon ◽

Jennifer E. Flythe

Keyword(s):

Intradialytic Hypotension

Download Full-text

Pneumatic Compression, But Not Exercise, Can Avoid Intradialytic Hypotension: A Randomized Trial

American Journal of Nephrology ◽

10.1159/000471513 ◽

2017 ◽

Vol 45 (5) ◽

pp. 409-416 ◽

Cited By ~ 8

Author(s):

Valeria R.C. Álvares ◽

Camila D. Ramos ◽

Benedito J. Pereira ◽

Ana Lucia Pinto ◽

Rosa M.A. Moysés ◽

...

Keyword(s):

Blood Pressure Measurement ◽

Extracellular Fluid ◽

Bioelectrical Impedance ◽

Phosphate Removal ◽

Crossover Fashion ◽

Intradialytic Hypotension ◽

Ultrafiltration Rate ◽

Induced Hypotension ◽

Conventional Hemodialysis ◽

Fluid Parameters

Background: Conventional hemodialysis (HD) is associated with dialysis-induced hypotension (DIH) and ineffective phosphate removal. As the main source of extracellular fluid removed during HD are the legs, we sought to reduce DIH and increase phosphate removal by using cycling and pneumatic compression, which would potentially provide higher venous return, preserving central blood flow and also offering more phosphate to the dialyzer. Methods: We evaluated 21 patients in a randomized crossover fashion in which each patient underwent 3 different HD: control; cycling exercise during the first 60 min; and pneumatic compression during the first 60 min. Data obtained included bioelectrical impedance, hourly blood pressure measurement, biochemical parameters, and direct quantification of phosphate through the dialysate. DIH was defined as a drop in mean arterial pressure (MAP) ≥20 mm Hg. Results: There was no difference in the ultrafiltration rate (p = 0.628), delta weight (p = 0.415), delta of total, intra and extracellular body water among the control, cycling, and pneumatic compression (p = 0.209, p = 0.348, and p = 0.467 respectively). Delta MAP was less changed by pneumatic compression when compared to control, cycling, and pneumatic compression respectively (-4.7 [-17.2, 8.2], -4.7 [-20.5, -0.2], and -2.3 [-8.1, 9.0] mm Hg; p = 0.021). DIH occurred in 43, 38, and 24% of patients in control, cycling, and pneumatic compression respectively (p = 0.014). Phosphate removal did not increase in any intervention (p = 0.486). Higher phosphate removal was dependent on ultrafiltration, pre dialysis serum phosphate, and higher parathyroid hormone. Conclusion: Pneumatic compression during the first hour of dialysis was associated with less DIH, albeit there was no effect on fluid parameters. Neither exercise nor pneumatic compression increased phosphate removal.

Download Full-text

Prevention of Intradialytic Hypotension in Patients with Acute Kidney Injury Submitted to Sustained Low-Efficiency Dialysis

Renal Failure ◽

10.3109/0886022x.2012.723581 ◽

2012 ◽

Vol 34 (10) ◽

pp. 1238-1243 ◽

Cited By ~ 13

Author(s):

Emerson Q. Lima ◽

Ricardo G. Silva ◽

Endrigo L.S. Donadi ◽

Alex B. Fernandes ◽

Jeferson R. Zanon ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Intradialytic Hypotension ◽

Low Efficiency

Download Full-text

Excessive Pressure in Multichambered Cuffs Used for Sequential Compression Therapy

Physical Therapy ◽

10.1093/ptj/82.10.1000 ◽

2002 ◽

Vol 82 (10) ◽

pp. 1000-1008 ◽

Cited By ~ 33

Author(s):

Patrick Segers ◽

Jean-Paul Belgrado ◽

Andre Leduc ◽

Olivier Leduc ◽

Pascal Verdonck

Keyword(s):

Time Course ◽

Compression Therapy ◽

Lymphatic Drainage ◽

Chamber Pressure ◽

Excessive Pressure ◽

Ellipsoidal Model ◽

Order Of Magnitude ◽

Pneumatic Compression Devices ◽

Target Pressure ◽

The Relationship

Abstract Background and Purpose. Pneumatic compression devices, used as part of the therapeutic strategy for lymphatic drainage, often have cuffs with multiple chambers that are inflated sequentially. The purpose of this study was to investigate (1) the relationship between cuff chamber pressure (Pchamber) and the pressure on the cuff-skin interface (Pinterface) and (2) the mechanical interaction of cuff chambers and consequences for device control. Subjects and Methods. In this study, we used 3 cylindrical (60-, 80-, and 100-mm-diameter) model limbs and 1 ellipsoidal model of the arm to test a commercially available pressure controller using “target pressures,” indicated by the controller, of 30, 60, 80, and 100 mm Hg. We studied the time course of Pchamber and Pinterface during the inflation sequence and the effect of local curvature on Pinterface. Results. Our data indicated that, overall, Pinterface is of the same order of magnitude as Pchamber. There was some effect of model diameter and shape, with the smaller curvatures yielding the highest Pinterface. Cuff chamber interaction led to Pchamber and Pinterface values in the most distal (first inflated) chamber that were up to 80% higher than the target pressure. For the 80-mm cylindrical model, for instance, pressure in this chamber reached 54, 98, 121, and 141 mm Hg, respectively, instead of the 30, 60, 80, and 100 mm Hg indicated by the controller. Discussion and Conclusion. The discrepancy between the target pressure, indicated by the controller, and the pressure measured inside the cuff chambers undermines the therapeutic control and efficacy of the pneumatic compression devices. Because the measured pressures were far beyond the pressure level indicated by the controller, it is recommended that pneumatic compression devices be used at much lower target pressures (<30 mm Hg) than those applied in clinical practice.

Download Full-text